Case Study: Managing CHF with a Focus on Care, Treatment & Education

This case study focuses on a 76-year-old male patient, Mr. P, with cardiomyopathy and congestive heart failure (CHF). The solution outlines a person-centered care approach aimed at resolving his self-care challenges and enhancing his quality of life. The recommended treatment plan prioritizes addressing drug-related issues, minimizing polypharmacy, and utilizing cognitive behavior therapy (CBT) tailored to his needs. The solution emphasizes the use of the teach-back method to improve patient and family engagement in medical decision-making. The teaching plan includes weight monitoring, medication management, cardiac rehabilitation, and the importance of follow-up sessions, all explained in accessible language. This assignment showcases a comprehensive strategy for managing CHF, integrating medical and educational interventions to improve patient outcomes and family support.

Running head: CASE STUDY-2
Case Study – 2
Your First and Last Name
Institutional Affiliation

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Case Study – 2
Care Approach
Mr. P’s care approach is based on the resolution of his self-care challenges through
the administration of person-centered interventions. The self-care approach in Mr. P’s case
should be administered in a manner to enhance his quality of life, coping strategies, and
self-confidence level (Rafii, Fatemi, Danielson, Johansson, & Modanloo, 2014). The care-
approach must effectively promote the active participation of Mr. P in his treatment
measures. The dietary education in Mr. P’s case should be imparted in a manner to achieve
the desired sodium management goals. The education sessions should promote the
engagement of Mr. P’s spouse while prioritizing his family considerations/financial
constraints, cultural context, and issues related to food access (Abshire, et al., 2015). The
individualized follow-up sessions must be undertaken to evaluate Mr. P’s dietary compliance
while encouraging him to follow the diet plan through therapeutic communication. The
development of a positive therapeutic interpersonal relationship between Mr. P and his
treating physician/nurse and is highly needed in the context of enhancing the overall
patient-clinician experience. The use of therapeutic communication with Mr. P is also
required to increase his engagement in the process of shared decision-making for achieving
the therapeutic targets (Kornhaber, Walsh, Duff, & Walker, 2016). The establishment of a
person-centered therapeutic relationship with Mr. P is substantially needed to address his
unmet requirements/emotional complications and elevate medication compliance in the
context of enhancing the wellness outcomes.
Treatment Plan
The interprofessional health care team requires prioritizing Mr. P’s drug-related
issues while minimizing the pill burden and screening the adverse drug-withdrawal episodes

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(Farrell, Shamji, Monahan, & Merkley, 2013). Utilization of appropriate tapering strategies is
also recommended to effectively optimize Mr.P’s dose administration in the treatment
setting. The assessment of lower treatment threshold in Mr. P’s case is highly necessary to
reduce the quantity and dosages of the prescribed medicine (McCracken, McCormack,
McGregor, Wong, & Garrison, 2017). This step will substantially assist Mr. P to overcome his
polypharmacy issues and minimize the risk of overtreatment. The customization of CBT
(Cognitive Behavior Therapy) in accordance with Mr. P’s personalized requirements and
level of distress is highly needed to minimize the intensity and frequency of his
dysfunctional beliefs (Chand & Huecker, 2018). The administration of behavioral change
interventions is also needed to effectively elevate the adherence of Mr. P to the
recommended diet and medication (Thom & Lean, 2017). Mr. P should be encouraged to
undertake diaphragmatic breathing or deep breathing exercise in the context of enhancing
his respiratory health. This diaphragmatic breathing will also prove to be an effective mind-
body intervention in the context of enhancing Mr. P’s mental health outcomes (Ma et al.,
2017).
Education Method and Rationale
Health care professionals should utilize the teach-back educational method to
improve the participation of Mr. P and his family persons in medical decision-making
process while improving the quality/safety of health care interventions (Klingbeil & Gibson,
2018). The clinicians/nurses initially require explaining the disease management strategies
to Mr. P and his caretakers and subsequently ask them to repeat their understanding of the
health care plan. This method will provide a platform for Mr. P and his family members to
ascertain their understanding of the disease and its health care approaches while clarifying
their doubts and discrepancies through questions and clarification. The teach-back method

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will also provide an opportunity for the patient and his family members in the context of
experiencing an extended communication with the treatment providers and overcome
information gaps through mutual collaboration. The physicians and nurses will have the
privilege to utilize various educational materials/platforms to enhance the presentation of
educational material for patients and their caretakers. These materials/platforms include
power point presentations, charts, video sessions, charts, posters, podcasts, analogies,
demonstrations, models, and group classes. Teach-back intervention in Mr. P’s case will
prove to be an efficient and robust strategy to improve his self-monitoring and self-
management capacity (Porter et al., 2016). Teach-back intervention in this manner will
assist Mr. P to evaluate his potential of dealing with the chronic disease manifestations and
overcoming the treatment barriers. Teach-back intervention will substantially enhance Mr.
P’s mental health and behavior to an unprecedented level.
Teaching Plan
The teaching plan will be based on the following significant steps (Denise, 2009).
1. Weight Monitoring: The health care professional will guide the patient to evaluate
his weight per day and record the finding on a diary to check the weight gain/loss
pattern. The patient will be required to record his weight in pounds and update any
variation in weight to the concerned clinician/nurse.
2. Discharge Medications: The clinician will explain the significance of using
diuretic/CHF medications strictly in accordance with their recommended dosages.
The clinician will compassionately instruct Mr. P for not changing his medication
dosage in case of weight gain and inform the concerned health care professional for
re-evaluating the therapeutic regimen.

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3. Cardiac Rehabilitation: The clinician will explain the importance of regular physical
activity /walking and recommended-diet to enhance Mr. P’s quality of life and
treatment outcomes.
4. Follow-Up: The clinician will emphasize the significance of follow-up sessions while
explaining the need for medication adherence.

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References
Abshire, M., Xu, J., Baptiste, D., Almansa, J. R., Xu, J., Cummings, A., . . . Himmelfarb, C.
D. (2015). Nutritional interventions in heart failure: A systematic review of the
literature. J Card Fail., 21(12), 989-999. doi:10.1016/j.cardfail.2015.10.004
Chand, S. P., & Huecker, M. R. (2018). Cognitive Behavior Therapy (CBT). In StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing. Retrieved from
https://www.ncbi.nlm.nih.gov/books/NBK470241/
Denise, B. (2009). Nursing Management. LNC, 40(9). Retrieved from
https://www.nursingcenter.com/journalarticle?
Article_ID=940643&Journal_ID=54013&Issue_ID=940640
Farrell, B., Shamji, S., Monahan, A., & Merkley, V. F. (2013). Reducing polypharmacy in
the elderly - Cases to help you “rock the boat”. Can Pharm J (Ott), 243-244.
doi:10.1177/1715163513499530
Klingbeil , C., & Gibson , C. (2018). The Teach Back Project: A System-wide Evidence
Based Practice Implementation. J Pediatr Nurs, 81-85.
doi:10.1016/j.pedn.2018.06.002
Kornhaber, R., Walsh, K., Duff, J., & Walker, K. (2016). Enhancing adult therapeutic
interpersonal relationships in the acute health care setting: an integrative review. J
Multidiscip Healthc, 537-546. doi:10.2147/JMDH.S116957
Ma, X., Yue, Z. Q., Gong, Z. Q., Zhang, H., Duan, N. Y., Shi, Y. T., . . . Li, Y. F. (2017). The
Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in
Healthy Adults. Front Psychol., 1-12. doi:10.3389/fpsyg.2017.00874

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McCracken, R., McCormack, J., McGregor, M. J., Wong, S. T., & Garrison, S. (2017).
Associations between polypharmacy and treatment intensity for hypertension and
diabetes: a cross-sectional study of nursing home patients in British Columbia,
Canada. BMJ Open, 7(8), 1-6. doi:10.1136/bmjopen-2017-017430
Porter, K., Chen, Y., Estabrooks, P., Noel, L., Bailey, A., & Zoellner, J. (2016). Using Teach-
Back to Understand Participant Behavioral Self-Monitoring Skills across Health
Literacy Level and Behavioral Condition. J Nutr Educ Behav, 20-26.
doi:10.1016/j.jneb.2015.08.012
Rafii, F., Fatemi, N. S., Danielson, E., Johansson, C. M., & Modanloo, M. (2014).
Compliance to treatment in patients with chronic illness: A concept exploration. Iran
J Nurs Midwifery Res, 19(2), 159-167. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4020025/
Thom, G., & Lean, M. (2017). Is There an Optimal Diet for Weight Management and
Metabolic Health? Gastroenterology, 152(7), 1739-1751.
doi:10.1053/j.gastro.2017.01.056. Epub 2017 Feb 15.

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